Prior Auth Required

19396 - Preparation of moulage for custom breast implant

This procedure appears on the selected insurer prior authorization source.

Prior authorizationPrior Auth Required
Procedure / ServicePreparation of moulage for custom breast implant
Procedure / Service Description

Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy - autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction) 19396 Preparation of moulage for custom breast implant 20912 Cartilage graft; nasal septum 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.